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  <title>处方单</title>
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    <h1 class="center">勉县医院门诊导诊单</h1>
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      <div style="margin-bottom: 8px;">
        <label for="">卡号:</label>
        <i class="f21 bb iccid">HH180621920</i>
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      <div style="margin-left: 40px;margin-bottom: 8px;">
        <label for="">日期:</label>
        <input type="text" value="" placeholder="2018-05-22" class="more input_date">
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      <div class="print_border"></div>
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    <div class="section2">
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        <label for="">姓名:</label>
        <input type="text" value="" placeholder="" class="bb">
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      <div style="margin-left:27px;">
        <label for="">性别:</label>
        <input type="text" value="" placeholder="" class="bb small">
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      <div style="margin-left:20px;">
        <label for="">年龄:</label>
        <input type="text" value="" placeholder="" class="bb small">
        <label for="">岁</label>
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    <div class="section1">
      <div>
        <label for="" class="f16 ml15">主要:</label>
        <input type="text" value="健康查体" placeholder="" class="more f16">
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    <div class="section1">
      <div class="ml5">
        <label for="" class="bb f16">处置科室:</label>
        <input type="text" value="门诊西药房" placeholder="门诊西药房" class="more f16">
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      <div class="mr15"><label for="" class="bb f16">项目</label></div>
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    <div class="other_fee2"></div>
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    <div class="medical"></div>
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        <label for="">开单医生:</label>
        <input type="text" value="" placeholder="" class="doctor">
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        <label for="">位置:</label>
        <input type="text" value="" placeholder="" class="long">
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    <div class="other_fee1" style="margin-top: 5px;"></div>
    <div class="section1">&#10142;此单仅作门诊导诊使用, 不做缴费凭证;</div>
    <div class="section1">&#10142;缴费请到门诊收费处缴费。</div>
    <div class="section1 bb">&#10142;就诊时, 请主动出示此“导诊单和缴费发票”</div>
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